1
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Clergue-Duval V, Vrillon A, Jeanblanc J, Questel F, Azuar J, Fouquet G, Mouton-Liger F, Rollet D, Hispard E, Bouaziz-Amar E, Bloch V, Dereux A, Cognat E, Marie-Claire C, Laplanche JL, Bellivier F, Paquet C, Naassila M, Vorspan F. Plasma tau, NfL, GFAP and UCHL1 as candidate biomarkers of alcohol withdrawal-associated brain damage: A pilot study. Addict Biol 2022; 27:e13232. [PMID: 36301211 DOI: 10.1111/adb.13232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 01/24/2023]
Abstract
In this translational study, we investigated the plasma tau protein, neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCHL1), which are established biomarkers of neurological injury, as predictive biomarkers of alcohol withdrawal-associated brain toxicity. In the clinical study, patients with severe alcohol use disorder (AUD) on D1 of hospitalization for alcohol cessation (AC) (N = 36) were compared to severe AUD patients with at least 3 months of abstinence (N = 16). Overall, patients were 40 men (76.9%), aged 49.8 years [SD ±9.9]. Tau, NfL, GFAP and UCHL1 levels were measured using SIMOA and analysed with a quasipoisson regression model adjusted for age and sex. The NfL level was higher in the AC group (p = 0.013). In the AC group, the tau (p = 0.021) and UCHL1 (p = 0.021) levels were positively associated with the dose of diazepam per weight, and the tau (p = 0.045), NfL (p = 4.9 × 10-3 ) and UCHL1 (p = 0.036) levels were higher in the presence of signs of Wernicke's encephalopathy (n = 9). In the preclinical study, NfL and GFAP levels were assessed in the alcohol deprivation effect (ADE) procedure (N = 17) and control Wistar rats (N = 15). Furthermore, ADE rats were prospectively assessed: after 24 h (T1) and 3 weeks of AC (T2) (paired-samples Wilcoxon and Mann-Whitney tests). The NfL level was higher in the ADE model than in the control rats at both T1 and T2 (p = 0.033 and p = 1.3 × 10-3 ) and higher at T2 than at T1 (p = 0.040). Plasma tau, NfL and UCHL1 are potential biomarkers of brain suffering during alcohol withdrawal.
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Affiliation(s)
- Virgile Clergue-Duval
- Département de Psychiatrie et de Médecine Addictologique, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France.,Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,UFR de Médecine, Université Paris Cité, Paris, France.,Resalcog (Réseau pour la prise en charge des troubles cognitifs liés à l'alcool), Paris, France
| | - Agathe Vrillon
- Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,UFR de Médecine, Université Paris Cité, Paris, France.,Centre de Neurologie Cognitive, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Jérôme Jeanblanc
- Inserm UMRS-1247 Groupe de recherche sur l'alcool et les pharmacodépendances, Université de Picardie Jules Verne, Amiens, France.,FHU Améliorer le pronostic des troubles Addictifs et Mentaux par une Médecine Personnalisée (A2M2P), Amiens, France
| | - Frank Questel
- Département de Psychiatrie et de Médecine Addictologique, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France.,Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,Resalcog (Réseau pour la prise en charge des troubles cognitifs liés à l'alcool), Paris, France
| | - Julien Azuar
- Département de Psychiatrie et de Médecine Addictologique, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France.,Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,Resalcog (Réseau pour la prise en charge des troubles cognitifs liés à l'alcool), Paris, France
| | - Grégory Fouquet
- Inserm UMRS-1247 Groupe de recherche sur l'alcool et les pharmacodépendances, Université de Picardie Jules Verne, Amiens, France.,FHU Améliorer le pronostic des troubles Addictifs et Mentaux par une Médecine Personnalisée (A2M2P), Amiens, France
| | - François Mouton-Liger
- Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,UFR de Médecine, Université Paris Cité, Paris, France.,Centre de Neurologie Cognitive, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Dorian Rollet
- Département de Psychiatrie et de Médecine Addictologique, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,Resalcog (Réseau pour la prise en charge des troubles cognitifs liés à l'alcool), Paris, France
| | - Eric Hispard
- Département de Psychiatrie et de Médecine Addictologique, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,Resalcog (Réseau pour la prise en charge des troubles cognitifs liés à l'alcool), Paris, France
| | - Elodie Bouaziz-Amar
- Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,Département de Biochimie et Biologie Moléculaire, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France.,UFR de Pharmacie, Université Paris Cité, Paris, France
| | - Vanessa Bloch
- Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,UFR de Pharmacie, Université Paris Cité, Paris, France.,Service de Pharmacie, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Alexandra Dereux
- Département de Psychiatrie et de Médecine Addictologique, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France.,Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,Resalcog (Réseau pour la prise en charge des troubles cognitifs liés à l'alcool), Paris, France
| | - Emmanuel Cognat
- Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,UFR de Médecine, Université Paris Cité, Paris, France.,Centre de Neurologie Cognitive, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Cynthia Marie-Claire
- Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France
| | - Jean-Louis Laplanche
- Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,Département de Biochimie et Biologie Moléculaire, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France.,UFR de Pharmacie, Université Paris Cité, Paris, France
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France.,Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,UFR de Médecine, Université Paris Cité, Paris, France
| | - Claire Paquet
- Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,UFR de Médecine, Université Paris Cité, Paris, France.,Centre de Neurologie Cognitive, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Mickael Naassila
- Inserm UMRS-1247 Groupe de recherche sur l'alcool et les pharmacodépendances, Université de Picardie Jules Verne, Amiens, France.,FHU Améliorer le pronostic des troubles Addictifs et Mentaux par une Médecine Personnalisée (A2M2P), Amiens, France.,UFR de Pharmacie, Université de Picardie Jules Verne, Amiens, France
| | - Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, APHP GHU Nord, Site Lariboisière Fernand-Widal, Paris, France.,Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université Paris Cité, Paris, France.,FHU Network of Research in Substance Use Disorders (NOR-SUD), Paris, France.,UFR de Médecine, Université Paris Cité, Paris, France
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2
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Yunusoğlu O. Evaluation of the effects of quercetin on the rewarding property of ethanol in mice. Neurosci Lett 2022; 768:136383. [PMID: 34864087 DOI: 10.1016/j.neulet.2021.136383] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND The flavonoid quercetin has several pharmacological effects on the nervous system. Previous research showed that quercetin has useful influences on some mechanisms that are relevant in drug and substance addiction. Alcohol addiction, also known as alcoholism, is a disorder that influences the population in all walks of life. The purpose of the current study was to investigate whether quercetin affects the acquisition, extinction, and reinstatement of ethanol-induced conditioned place preference (ethanol-CPP) in adolescent mice. METHODS CPP was established by administration of intraperitoneal (i.p.) ethanol (2.0 g/kg) in a conditioning trial. The mice were pretreated with quercetin (at doses of 10, 30, and 100 mg/kg, i.p.) 30 minutes before each ethanol injection to test the effects of quercetin on the reward properties of ethanol. Ethanol-CPP was extinguished (13-days) by repeated testing, during which conditioned mice were given different doses of quercetin every day. Lastly, efficacy of quercetin in preventing reinstatement of ethanol-CPP triggers was also assessed by the administration of single dose ethanol (0.4 g/kg, i.p.). RESULTS Quercetin pretreatment attenuated the acquisition and reinstatement. In addition, quercetin administration accelerated the extinction of ethanol-CPP. CONCLUSIONS In conclusion, these results may cast a novel light on quercetin as an agent that could be potentially useful to attenuate different effects of ethanol and as adjuvant pharmacotherapy for ethanol addiction. However, future studies are needed to demonstrate the detailed underlying mechanisms of quercetin on ethanol addiction.
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Affiliation(s)
- Oruç Yunusoğlu
- Bolu Abant Izzet Baysal University, Faculty of Medicine, Medical Pharmacology, 14030 Bolu, Turkey.
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3
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Antwerpes S, Costa M, Coste M, Bureau M, Maradan G, Cutarella C, Leloutre J, Riccobono-Soulier O, Hedoire S, Frot E, Vernier F, Vassas-Goyard S, Barré T, Casanova D, Carrieri P. Evaluation of a novel therapeutic education programme for people with alcohol use disorder in France: a mixed-methods intervention study protocol (ETHER). Harm Reduct J 2022; 19:2. [PMID: 35012570 PMCID: PMC8751002 DOI: 10.1186/s12954-021-00587-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND ETHER ("Education THEérapeutique pour la Réduction des dommages en alcoologie" or Therapeutic education for alcohol-related harm reduction) is a multicentre community-based mixed-methods study, which aims to evaluate the effectiveness of the innovative therapeutic patient education (TPE) programme 'Choizitaconso' in a sample of French people with alcohol use disorder (people with AUD). Choizitaconso teaches people with AUD psychosocial skills to help them (re)establish controlled drinking and reduce alcohol-related harms. Recruitment started in October 2019. We present here the protocol of the ETHER study. METHODS ETHER's quantitative component involves a 6-month controlled intervention study which evaluates Choizitaconso's effectiveness by comparing 30 people with AUD following the programme with a control group of 60 people with AUD not enrolled in it, using a questionnaire co-constructed by the research team and members of the people with AUD community. Thirty-four alcohol-related harms are assessed and summed to provide an individual measure of the 'harm burden' from consuming alcohol (primary outcome). Secondary outcomes are anticipated and internalized stigma, alcohol consumption measures, craving for alcohol, coping strategies, health-related quality of life, self-confidence to control or abstain from drinking, treatment self-regulation, anxiety and depressive symptoms, alcohol-related neuropsychological impairments, and capabilities (a measure of wellbeing in adults). Data will be collected in face-to-face and phone-based interviews at enrolment and 6 months later. Linear regression models will be used to assess the impact of the TPE programme on changes in the primary and secondary outcomes, while adjusting for other correlates and confounders. The study's qualitative component comprises semi-structured interviews with 16 people with AUD who have already completed the TPE programme at least 6 months before the interview. Qualitative interviews will be analysed using thematic analysis. RESULTS AND CONCLUSIONS ETHER is the first evaluation study of an innovative TPE programme specifically designed to reduce alcohol-related harms and reach controlled drinking in France. The involvement of the people with AUD community in selecting which experienced and perceived alcohol-related harms to measure ensures that ETHER will provide healthcare staff and researchers with a relevant set of harm reduction criteria for use in future research. Finally, ETHER will provide scientific justification for implementing novel alcohol-related harm reduction approaches and champion controlled drinking as a therapeutic goal. Trial registration ClinicalTrials.gov, NCT03954054. Registered 17 May 2019-Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT03954054?cond=alcohol&cntry=FR&city=Marseille&draw=1&rank=1 .
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Affiliation(s)
- Saskia Antwerpes
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France
| | - Marie Costa
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France
| | - Marion Coste
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France
| | - Morgane Bureau
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France
| | - Gwenaelle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France
| | - Christophe Cutarella
- Clinique Saint-Barnabé, Marseille, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
| | - Jacques Leloutre
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Avignon, France
| | - Olivier Riccobono-Soulier
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Avignon, France
| | | | - Elodie Frot
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Avignon, France
| | - Fabienne Vernier
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Avignon, France
| | - Stéphanie Vassas-Goyard
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Avignon, France
| | - Tangui Barré
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France.
| | - Danielle Casanova
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Avignon, France
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France
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4
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Kouimtsidis C, Houghton B, Gage H, Notley C, Maskrey V, Clark A, Holland R, Lingford-Hughes A, Punukollu B, Touray M, Duka T. A feasibility trial of an intervention in alcohol dependence for structured preparation before detoxification versus usual care: the SPADe trial results. Pilot Feasibility Stud 2021; 7:148. [PMID: 34325743 PMCID: PMC8320093 DOI: 10.1186/s40814-021-00880-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Individuals who are 'moderately' or 'severely' dependent consume alcohol at levels that are likely to have a severe impact on their own health and mortality, the health and behaviours of others (family members) and to have economic and social implications. Treatment guidelines suggest that treatment needs to be planned with medically assisted withdrawal (also referred to as detoxification), and aftercare support but outcomes are poor with low proportions engaging in after care and high relapse rates. An approach of structured preparation before alcohol detoxification (SPADe) puts an emphasis on introducing lifestyle changes, development of coping strategies for cravings, stress and emotions as well as introducing changes to the immediate family and social environment in advance of alcohol cessation. Such a pre-habilitation paradigm compliments the established treatment approach. The key research question was: can we design a large scale, randomised controlled trial (RCT) that will answer whether such an approach is more effective than usual care in helping individuals to maintain longer periods of alcohol abstinence? METHODS This is a pragmatic, parallel, two-arm, feasibility RCT comparing SPADe and usual care against usual care only in maintaining alcohol abstinence in adults with alcohol dependence receiving care in two community addiction services in London. Feasibility outcomes, exploration of primary and secondary clinical outcomes and health economic outcomes are analysed. The trial follows the guidelines of phase 2 of the Medical Research Council (MRC) for complex interventions. RESULTS We were able to recruit 48/50 participants during a period of 9 months. Retention in the trial for the whole period of the 12 months was 75%. Treatment compliance was overall 44%. Data completion for the primary outcome was 65%, 50% and 63% at 3, 6 and 12 months, respectively. The intervention group had more days abstinent in the previous 90 days at the 12 months (n = 54.5) versus control (n = 41.5). CONCLUSIONS The results of this feasibility trial indicate that with the appropriate modifications, a full multicentred trial would be possible to test the effectiveness and cost-effectiveness of a pre-habilitation approach such as the SPADe group intervention in addition to usual care against usual care only. TRIAL REGISTRATION Name of registry: ISRCTN; Trial Registration Number: 14621127 ; Date of Registration: 22/02/2017.
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Affiliation(s)
- Christos Kouimtsidis
- Surrey & Borders NHS Trust, Research and Development, Abraham Cowley Uni, Chertsey, Surrey, KT16 0AE UK
| | - Ben Houghton
- Surrey & Borders NHS Trust, Research and Development, Abraham Cowley Uni, Chertsey, Surrey, KT16 0AE UK
| | - Heather Gage
- University of Surrey, 388 Stag Hill, Guildford, GU2 7XH UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ UK
| | - Vivienne Maskrey
- University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ UK
| | - Allan Clark
- University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ UK
| | - Richard Holland
- University of Leicester, University Road, Leicester, LE1 7RH UK
| | - Anne Lingford-Hughes
- Imperial College London, Burlington Danes Building, Hammersmith Campus, 160 Du Cane Road, London, W12 0NN UK
| | - Bhaskar Punukollu
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, Kings Cross, London, NW1 0PE UK
| | - Morro Touray
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ UK
| | - Theodora Duka
- University of Sussex, School of Psychology, Falmer, Brighton, BN1 9RH UK
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5
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Kouimtsidis C, Pauly B, Parkes T, Stockwell T, Baldacchino AM. COVID-19 Social Restrictions: An Opportunity to Re-visit the Concept of Harm Reduction in the Treatment of Alcohol Dependence. A Position Paper. Front Psychiatry 2021; 12:623649. [PMID: 33679480 PMCID: PMC7930817 DOI: 10.3389/fpsyt.2021.623649] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/01/2021] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic is presenting significant challenges for health and social care systems globally. The implementation of unprecedented public health measures, alongside the augmentation of the treatment capacity for those severely affected by COVID-19, are compromising and limiting the delivery of essential care to people with severe substance use problems and, in some cases, widening extreme social inequities such as poverty and homelessness. This global pandemic is severely challenging current working practices. However, these challenges can provide a unique opportunity for a flexible and innovative learning approach, bringing certain interventions into the spotlight. Harm reduction responses are well-established evidenced approaches in the management of opioid dependence but not so well-known or implemented in relation to alcohol use disorders. In this position paper, we explore the potential for expanding harm reduction approaches during the COVID-19 crisis and beyond as part of substance use treatment services. We will examine alcohol use and related vulnerabilities during COVID-19, the impact of COVID-19 on substance use services, and the potential philosophical shift in orientation to harm reduction and outline a range of alcohol harm reduction approaches. We discuss relevant aspects of the Structured Preparation for Alcohol Detoxification (SPADe) treatment model, and Managed Alcohol Programs (MAPs), as part of a continuum of harm reduction and abstinence orientated treatment for alcohol use disorders. In conclusion, while COVID-19 has dramatically reduced and limited services, the pandemic has propelled the importance of alcohol harm reduction and created new opportunities for implementation of harm reduction philosophy and approaches, including programs that incorporate the provision of alcohol as medicine as part of the substance use treatment continuum.
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Affiliation(s)
- Christos Kouimtsidis
- Imperial College London and Surrey and Borders Partnership NHS Foundation Trust, London, United Kingdom
| | - Bernadette Pauly
- Canadian Institute for Substance Use Research, University of Victoria School of Nursing, Victoria, BC, Canada
| | - Tessa Parkes
- Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Tim Stockwell
- University of Victoria, Canadian Institute for Substance Use Research, Victoria, BC, Canada
| | - Alexander Mario Baldacchino
- Population and Behavioural Science Division, Medical School, St Andrews University, St Andrews, United Kingdom
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6
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Laniepce A, Cabé N, André C, Bertran F, Boudehent C, Lahbairi N, Maillard A, Mary A, Segobin S, Vabret F, Rauchs G, Pitel AL. The effect of alcohol withdrawal syndrome severity on sleep, brain and cognition. Brain Commun 2020; 2:fcaa123. [PMID: 33543128 PMCID: PMC7846181 DOI: 10.1093/braincomms/fcaa123] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/22/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022] Open
Abstract
In alcohol use disorder, drinking cessation is frequently associated with an alcohol withdrawal syndrome. Early in abstinence (within the first 2 months after drinking cessation), when patients do not exhibit physical signs of alcohol withdrawal syndrome anymore (such as nausea, tremor or anxiety), studies report various brain, sleep and cognitive alterations, highly heterogeneous from one patient to another. While the acute neurotoxicity of alcohol withdrawal syndrome is well-known, its contribution to structural brain alterations, sleep disturbances and neuropsychological deficits observed early in abstinence has never been investigated and is addressed in this study. We included 54 alcohol use disorder patients early in abstinence (from 4 to 21 days of sobriety) and 50 healthy controls. When acute physical signs of alcohol withdrawal syndrome were no longer present, patients performed a detailed neuropsychological assessment, a T1-weighted MRI and a polysomnography for a subgroup of patients. According to the severity of the clinical symptoms collected during the acute withdrawal period, patients were subsequently classified as mild alcohol withdrawal syndrome (mild-AWS) patients (Cushman score ≤ 4, no benzodiazepine prescription, N = 17) or moderate alcohol withdrawal syndrome (moderate-AWS) patients (Cushman score > 4, benzodiazepine prescription, N = 37). Patients with severe withdrawal complications (delirium tremens or seizures) were not included. Mild-AWS patients presented similar grey matter volume and sleep quality as healthy controls, but lower processing speed and episodic memory performance. Compared to healthy controls, moderate-AWS patients presented non-rapid eye movement sleep alterations, widespread grey matter shrinkage and lower performance for all the cognitive domains assessed (processing speed, short-term memory, executive functions and episodic memory). Moderate-AWS patients presented a lower percentage of slow-wave sleep, grey matter atrophy in fronto-insular and thalamus/hypothalamus regions, and lower short-term memory and executive performance than mild-AWS patients. Mediation analyses revealed both direct and indirect (via fronto-insular and thalamus/hypothalamus atrophy) relationships between poor sleep quality and cognitive performance. Alcohol withdrawal syndrome severity, which reflects neurotoxic hyperglutamatergic activity, should be considered as a critical factor for the development of non-rapid eye movement sleep alterations, fronto-insular atrophy and executive impairments in recently detoxified alcohol use disorder patients. The glutamatergic activity is involved in sleep-wake circuits and may thus contribute to molecular mechanisms underlying alcohol-related brain damage, resulting in cognitive deficits. Alcohol withdrawal syndrome severity and sleep quality deserve special attention for a better understanding and treatment of brain and cognitive alterations observed early in abstinence, and ultimately for more efficient relapse prevention strategies.
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Affiliation(s)
- Alice Laniepce
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Nicolas Cabé
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Claire André
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Françoise Bertran
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Céline Boudehent
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Najlaa Lahbairi
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Angéline Maillard
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Alison Mary
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Shailendra Segobin
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - François Vabret
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Géraldine Rauchs
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Anne-Lise Pitel
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
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